#2019GM-OCT
[!INFO] Concordance
Concordance exists when all the QRS complexes in the chest leads are either predominantly positive or predominantly negative. Source
Concordance can be Positive or Negative.
- Positive concordance suggests that the VT focus is in the posterior ventricular wall
- Negative cocordance suggests that the VT focus is in the anterior ventricular wall
- i.e it corresponds to the overall direction of depolarization relative to the chest eleads.
Source
ABCDE
In VT:
#2019GM-OCT/Q27
Source
Treponema pallidum cannot be cultured:
Serology and CSF examination are the mainstays for diagnosis. VDRL (Venereal Disease Research Laboratory) and RPR (rapid plasma reagin) tests are nontreponemal tests used for screening for syphilis.
AKA paretic neurosyphilis, dementia paralytica
A disease of the posterior columns and the dorsal roots.
Physical examination of late neurosyphilis:
Symptoms:
IV penicillin
#2019SBT-OCT/Q21
They occur due to defects in haem synthesis.
Acute porphyria:
Clinical features: Abdominal pain, neuropsychiatric features, seizures and fever.
Can be precipitated by anaesthetic drugs and luteal phase of the menstual cycle.
Anaesthesia for suspected acute abdomen can be catastrophic.
Chronic porphyrias
Nephrotic syndrome in adult can be caused secondary to systemic diseases.
Or due to primary nephropathies.
FSGS, MCD or Membranous nephropathy.
FSGS can be
Membranous nephropathy
^6ae35e
What teriparatide?
Teriparatide is a recombinant fragment of human parathyroid hormone consisting
Spongy bone = trabercular bone;
Compact bone = cortical bone.
Basically a syndrome of weak bones. (increased fragility).
Low bone mass + 'micro-architectural deterioration' leading to enhanced bone fragility and fracture risk.
Bone density is measured at the hip and the spine.
Loss of bone mass is due to
Risk factors for fragility fractures are BMD dependent or BMD-independent.
(? only the BMD dependent ones are risk factors for osteoporosis)
Major causes of low BMD explained:
Oestrogen deficiency
[!INFO] Oestrogen deficiency causes ⬆deposition & ⬆⬆⬆ resorption
Oestrogen AND androgen deficiency cause increased bone turover with increased osteoblastic deposition AND increased osteoblastic resorption but resorption >> deposition and this leads to overall loss of bone density.Source
Oestrogen deff also causes:
Glucocorticoids
Ageing
[!INFO] The gold standard is DXA
It measures bone density per square aread, NOT per unit volume. Even so, it is very accurate.
Falsely high values can be produces by osteophytes in the elderly.
The goal of management is to prevent future fractures.
Therefore, whether to treat or not and treatment option used depend on the current fracture risk. This is determined by risk scores such as the FRAX score.
Strongest predictor for future fractures is a history of fragility fracture. (i.e you have one, you're likely to get another)
In USA, for example, 10 year hip fracture risk > 3% or major osteoporotic fracture risk > 20% are indications to start treatment.
All block resorption except teriparatide.
[!INFO] Phamacologic options and efficacy
Raloxifene and Bazedoxifene prevent only vertebral fractures.
- They are rarely used to treat osteoporosis.
- Everything else works for both vertebral and non vertebral fractures.
- Hip fractures are not prevented by teriparatide and Ibandronate. (and also raloxifene and bazedoxifene)
[!TIP] Mnemonic:
Bind to bone hydroxyapetite and inhibit osteoclasts.
Alendronate and risendronate - once weekly dose
ibandronate - once monthly.
Zoledronate - once yearly infusion
Bisphophonates can be used in late CKD but with careful monitoring.
beware! osteonecrosis of the jaw! -> occurs with HIGH dose IV bisphophonates.
prolonged treatment itself can lead to atypical fractures -> treatment should probably be stopped if T score has improved above -2.5.
Human antibody against RANKL which causes decreased resorption. Given every 6 months. Prevents fractures at all sites. Few side effects. Can cause osteonecrosis of the jaw. Can cause dysuria.
rarely used due to cardiovascular and thromboembolic events.
Synthetic PTH analog -> has a 'paradoxical' effect of decreasing resorption.
When under continuous exposure to PTH (e.g., hyperparathyroidism), bone undergoes resorption more than formation, while intermittent exposure to low-dose PTH (like daily administration of teriparatide) induces bone formation more than resorption. Source
It's a daily sub cut injection ; difficult to take.
Used for resistant osteoporosis and severe vertebral osteoporosis.
Contraindicated for fractures due to skeletal mets and osteosarcoma.
[!TIP] SERMS: only for the spine
Rarely used to treat osteoposoris
Being 'selective', they don't act on the uterus.
They do act on bone and decrease resorption.
Site of action is tricky: They reduce fracture risk on at the vertebra but they do reduce resorption at both the hip and spine
Increased thromboembolic risk and flushing.
Not evidence backed; not used.
Mainstay of management is HSS is fluid.
Insulin is started only if the there is mild ketonaemia.
If there is acidosis (pH < 7.2 or HCO3 < 15) or high ketonemia, manage as DKA.
Primaquine reduces transmisibility. Main action is to eradicate hyponozoites. Also acts against gametocytes but has no effect against asexual blood stages.
(i.e so it works against hypnozoites and gametocytes)
[!INFO] There is significant overlap between conditions having RF and ANA
